By: Alanna Shaikh
We used to be able to divide global health problems into two pretty distinct categories: developed world diseases and developing world diseases. The developing world was beset by infectious diseases made worse by poverty: diarrhea, respiratory infections, polio, tuberculosis, NTDs, and so on. The developed world bore the brunt of chronic illnesses, worsened by wealthy lifestyles and the attendant abundance of food and lack of exercise: cardiovascular diseases, diabetes, obesity, cancer, and asthma.
An average nation had one kind of problem or the other. The rare country that faced both kinds of problems was described as having a “dual burden” of disease. Dual burden countries stood out, because it was an unusual situation and especially difficult to cope with.
We’re looking at a new world. Globalization and urbanization are bringing the negative health impacts of wealth (and few of the positives) to low-income countries. Asthma, heart disease, diabetes, and obesity are increasingly common in the developing world. At the same time, global air travel and trade are letting the old diseases of poverty spread far out of their traditional geographical limitations.
Which means that to a large degree we’re all dual burden countries now. We saw several outbreaks of dengue fever in Florida this year. Obesity is a major problem in Mexico, and on the rise in China, Morocco, and Kenya, among many other countries. And obesity brings along all its chronic illness friends, in particular diabetes and cardiovascular disease.
Dual burden countries have to cope with both kinds of problems. They need to fight both malnutrition and obesity, provide access to cancer treatment and to oral rehydration solution.[1] That’s a lot for any health system to handle, and it’s going to take some big adjustments globally to cope with the increased range of health problems we’re all facing.
Now, it seems, we need to think about the way that different diseases interact. It’s not just a case of having to cope with both NTDs and diabetes in the same population. It’s a case of figuring out how all these different conditions affect each other in the same person.
Here’s a start. Obesity makes dengue fever worse. Dengue fever makes you leaky. Your blood vessels let fluid out. In more technical language, “Dengue patients suffer from capillary permeability, when fluid leaks from their blood vessels into surrounding tissues, causing breathing difficulty and complications in major organs like the brain, liver and kidneys.” Obesity, it turns out, does the same thing. People with a high body mass index are “intrinsically more likely to leak.” As a result, dengue infections get bad faster, and are more prone to complications.
There don’t seem to be any high tech answers to these kinds of problems. Fighting them comes back to all the same stuff we already know we need to be doing better: we need to find vaccines, better treatments, and good surveillance for infectious diseases. We need to work to reduce the incidence of chronic diseases. And we need to support our health systems so all those things can actually happen.
[1] Sugar, salt, and maybe some potassium. The best way to keep ordinary diarrhea from becoming a child killer.
Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’ The views and opinions expressed by guest bloggers are not neccesarily the views and opinions of the Global Network. All opinions expressed here are Alanna’s own and not those of any employer or the US government.